Paediatric Imaging

Hermaphroditism

an intersex state divided into female and male pseudohermaphroditism, true hermaphroditism or mixed gonadal dysgenesis. Prompt sex assignment is of benefit to the patient and family and is based on results of karyotype analysis, gonadal biopsy and knowledge of genital anatomy. Sonography documents the presence or absence of a uterus.

True hermaphroditism is very rare and is a condition where an individual has both testicular and ovarian tissue. Frequently there are karyotypic abnormalities involving the sex chromosones.

There is variation in the gonad histology such that either gonad may be entirely ovarian tissue or entirely testicular tissue or each may be a combination of ovarian and testicular tissues. The ovaries are always within the abdominal cavity but the testes or ovo testes may be at any site within the abdomen, groin or scrotum. Almost all patients have a uterus although this may be rather small and the genitalia are usually ambiguous. Radiological investigation is that of a urogenital sinus when appropriate (Fig.1) (Fig.2). Sonography is indicated to assess the pelvic organs, supplemented by a MRI, if there is still confusion. For a general description, see hermaphroditism.

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Fig.1

Vaginogram showing filling of the bladder and vagina as part of a urogenital sinus.
Hermaphroditism, Fig.1
Hermaphroditism, Fig.2